Provider Demographics
NPI:1528427291
Name:CHA, BEDE SOON TAE (DO)
Entity type:Individual
Prefix:
First Name:BEDE SOON
Middle Name:TAE
Last Name:CHA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:BEDE
Other - Middle Name:SOONTAE
Other - Last Name:CHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3265 PEACHTREE PKWY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1036
Mailing Address - Country:US
Mailing Address - Phone:678-967-3182
Mailing Address - Fax:678-967-3363
Practice Address - Street 1:3265 PEACHTREE PKWY
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1036
Practice Address - Country:US
Practice Address - Phone:678-967-3182
Practice Address - Fax:678-967-3363
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA82830207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine